Non–High-Density Lipoprotein Cholesterol and Guidelines for Cholesterol Lowering in Recent History

Stanley S. Levinson, PhD


Lab Med. 2020;51(1):14-23. 

In This Article

Mechanism of ASCVD

Lindgren et al[28] first separated lipoprotein particles using analytical ultracentrifugation. These investigators found that the most buoyant lipoproteins were the chylomicrons, which float to the top during ultracentrifugation and the most-dense HDL, which sinks to the bottom, with the beta-lipoproteins floating in between. Although there are now other ways to separate lipoproteins, classification by density remains the preferred method and seems to have functional importance.[24]

Substantial evidence[10,29] indicates that LDL infiltrates the artery wall, where it is modified and rapidly taken up by macrophages that become lipid-laden foam cells—apparently, the first event in a sequence that leads to atherosclerotic plaque. Thus, high concentrations of LDL cause more penetration. Besides, smaller lipoproteins, such as sdLDL, and remnant particles, such as chylomicron remnants and IDL, are considered especially atherogenic because it is thought that they can more easily penetrate the artery wall.[10,27,30]